This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Tuesday, 18 September 2007

An Oldie but still a Goodie

Found this article during my web travels. Maybe my image for this post should have said "different day, different country, SAME OLD SHIT. This article is pretty old...2001 but it says a lot of things that are pertinent now. My belief is that things have really deteriorated since this article was written.

This piece is also American as is most of the other stuff I posted. It may be American but the stories that these nurses are telling could have come straight out of the mouths of British Nurses. I want to start seeing this stuff from British Journalists.

My lovely comments in bold.

Look, if you don't think that "medical economics" isn't completely fucking with the system here as much as it is in the USA than I am worried. Good care is no longer a priority. Making it appear that good care is the goal is the priority now. It doesn't matter if you are in an NHS hospital in Crapshire or BigBucks hospital in Bumblefuck,Wisconsin. It's all the same.

Same shit different country has always been my motto.

Prognosis poor in nursing shortage

Sunday, September 09, 2001

By Ford TurnerOf The Patriot-News

Nurse Kelli Diodato, less than two years out of Penn State University, worked at Harrisburg Hospital and had to care simultaneously for up to eight heart patients. People with "all kinds of IVs and chest tubes and lines in their arteries."

Diodato calls it "ridiculous." Four patients, she says, might have been an appropriate number.

Remember that advances in technology means that hospital patients are sicker, more complex and tougher to take care of than they were years ago.....Anne

One night last year, a supervisor insisted Diodato take responsibility for nine patients at one time. That night, she decided to get a new job.

"I just wasn't able to give the care I wanted. ... I felt rushed and I didn't have time to do complete assessments the way I wanted to do them. I was overwhelmed," Baer says.

Baer recently started a new job as a $9.25-an-hour middle-school health aide. ***

Sally Long, a nurse at Harrisburg State Hospital, says she has watched mentally ill people go to other hospitals for medical problems, only to lie in the emergency room -- sometimes for days -- until the hospitals have staffed, non-emergency beds available.

"In the last few months I've seen it happen half a dozen times, and really one time is too many," she says. ***

Ask a hospital nurse, hear a disturbing story.

Piece the stories together, form a disturbing portrait.

Hospital nurses in central Pennsylvania are running themselves ragged in the face of a national nursing shortage. Jesus are they talking about the UK?...Anne

They speak of stress, understaffing, and a widespread belief that the health care system puts money ahead of patient care. Veteran registered nurses -- the backbone of hospital nursing staffs -- are resigning in large numbers. Relatively few people are coming into the profession; hospital managers patch holes by hiring "temp" nurses and even by recruiting overseas.

Sound familiar? Would a UK hospital cull back staff to try and stay within budget? Would they pay out to bring in cheaper foreign nurses who aren't as likely to speak out when patient care is compromised? The correct answer is.... fuck yes........Anne

Of some three dozen midstate nurses interviewed by The Patriot-News, many say the shortage is compromising patient care, directly or indirectly.

They aren't alone.

Concern has grown nationwide over how patients are faring in the face of a shortage dramatized by some startling statistics:

Put a registered nurse in every one of the 106,537 seats at Penn State's Beaver Stadium, and cram about 20,000 more onto the football field -- that's how many nurses it would take to solve the nation's shortage. The number of people passing the national registered-nurse exam dropped 23 percent in the past five years, from about 98,000 to about 75,000, according to the General Accounting Office.

Yet there are over 500,000 licensed Registered Nurses in the USA who refuse to work in healthcare. The UK is heaving with Registered Nurses who will not work in Nursing. They all say the same thing....Love Nursing/Hate the overwhelming work loads and sheer terror that the job entails (and don't even get me started who the unreasonable public who demands one on one care from a nurse they are sharing with 20 other sick patients...........Anne

Enrollments in Pennsylvania nursing schools -- those offering standard entry-level programs -- has dropped by more than 35 percent since 1995, from about 5,800 to 3,800, according to the American Association of Colleges of Nursing. More than 40 percent of U.S. hospital nurses reported dissatisfaction with their jobs in a University of Pennsylvania study.

Two recently released studies -- one by Harvard and Vanderbilt universities, the other by the federal government -- concluded that care improves when more nurses are available. Although there have been nursing shortages in the past, this one is expected to last longer and hurt more. It is a numbers problem: The demand for nurses will surge as baby boomers reach their senior years. At the same time, the number of women between ages 25 and 54 -- the traditional core of the nurse work force -- is expected to remain unchanged.

But studies and statistics fail to convey the human side of nurses' everyday struggles.

Opportunities grow:

"Sometimes I come home and I cry," says one nurse who has worked at both Harrisburg and Holy Spirit hospitals. "People are really sick and they need good care." ***

"We feel kind of torn. We want to give the best care we can, and we do, but you fly around like a crazy person," says Christy Clippinger, a 36-year-old registered nurse who works in the operating room at Harrisburg Hospital.

***

Many things get blamed for the nursing shortage, including more opportunities for women outside of nursing, discontent among nurses, and staff cuts as managed care squeezes hospital finances.

With enrollment at U.S. nursing schools down from about 74,000 in 1995 to 58,000 last year, there are "fewer nurses in the educational pipeline," says a spokesman for the American Association of Colleges of Nursing.

The urgent question: Why?

"Girls aren't going into nursing anymore," says Lebanon resident Marie Garman, a licensed practical nurse for 35 years. "I don't know if they think it's demeaning or what, but it's not being pushed in high schools anymore, either."

Well I have banned my own daughter from a career in nursing. I wouldn't encourage anyone to enter the field. If you go to university and study anything else you will make more money, not have to know as much, not have to work as hard, work better hours and get more respect. It's a no brainer.......Anne

Meanwhile, non-nursing opportunities for women have exploded.

Leanne Clark, a 53-year-old nurse at Harrisburg Hospital, says that when she got out of high school "a woman either became a teacher, a secretary, a beautician or a nurse."

The wives of President Bush and Gov. Tom Ridge are librarians.

Today, women have opportunities in business, the military -- just about any field they choose.

Meanwhile, nurses' place in the health care system has changed dramatically.

Bill Cruice, director of the Pennsylvania Association of Staff Nurses and Allied Professionals in Conshohocken, says he believes the health care industry inflicted the shortage upon itself.

When managed care, in the mid-1990s, "decided that the health system would be driven by profit -- accountants and fancy consultants peddling their wares -- the entire atmosphere of what it meant to be a professional nurse on the front lines changed," he says. "Almost overnight it made being a nurse one of the most difficult jobs in the country."

Many hospitals cut 50 or more nursing positions as they sought to reduce costs in the late 1990s, says Jessie Rohner, executive administrator of the Pennsylvania State Nurses Association.

After that, he says, nurses felt no loyalty to their former employers. It became difficult to lure them back to the hospital.

Nurses also have seen job demands increase. Not just in patient care, but in scheduling.

Overtime -- described by some nurses as "mandatory," though most hospitals reject the term -- has become a drain on their lives. Some are told to work extra shifts every week. Others stay at work after their shift ends because they are a "DL," or designated late, nurse.

"When you work so many hours, you just aren't as good as you were at 7 a.m.," says a veteran nurse in the PinnacleHealth System.

Lydia Mogel, a nurse at Penn State Milton S. Hershey Medical Center, says her colleagues come to work sick "because if they call in sick, they get an 'occurrence' ... a written record that goes in your file."

Many nurses say the exodus from their profession is linked to a sea change in health care. Profits, they say, have become more important than patient care.

Profits/Targets/Budgets...whatever. Yes hospitals have to be fiscally responsible and not piss money away. But they have to make sure that they are putting the money into the right areas. Patient care would be a good start.......Anne

Their feelings are shared by Kerry M. Fagelman, a pediatric surgeon who practices at several midstate hospitals.

The shortage of nurses, he says, is compromising care in every hospital because the number of nurses available "has a direct impact on patient care and on patient mortality."

However, Fagelman -- who spent four years in medical school, eight years as a surgeon in training, and has had a surgical practice for 19 -- says the nursing shortage is one symptom of a much larger problem of "medical economics."

In short, he says, medicine has become a business in which health insurance companies and health care organizations suck away money that should go to providers such as nurses and doctors.

Sometimes they suck it away and put it towards stupid shit like more managers and paperwork as well as fucking stupid targets that merely give the appearance of better patient care. They resent having to provide nurses and doctors to care for patients let alone shuffle money their way in exchange for their hard work.....Anne

"It has come not to care, but to the dollar figure. How quickly can we get those patients in and out ... The care is not there that was there 10 years ago," says Cindy Fetchen, a 42-year-old registered nurse who works in operating rooms at Hershey Medical Center. ***

A 10-year veteran nurse at PinnacleHealth says: "It is more greed, toward money. It is a business. It is not geared toward the patient." She points to the recent shutdown of adult outpatient mental health services by PinnacleHealth as one example. ***

Another veteran PinnacleHealth nurse who requests anonymity says that, because of the nursing shortage, Harrisburg Hospital at times has had only nine of its 19 operating rooms functioning.

The crunch means patients sometimes are processed in a hurry.

The nurse says she saw surgeons ask for patients to be brought into surgery with prep work incomplete.

In April, the state fined PinnacleHealth for that very problem, along with an apparent breakdown in the procedure that surgeons use to verify the identity of some surgical patients. ***

While nurses are frustrated, they aren't complaining in a vacuum. Hospital officials acknowledge, and even echo, their complaints.

"Our job right now, as far as I am concerned, is to listen to them and understand what is going on in their work life, and try as much as we can to respond to it," says Roger Longenderfer, chief executive officer of PinnacleHealth. "We use a significant amount of agency nurses and temporary help -- that's a very short-term solution. We'd much rather have our own folks in place, but that does help fill the gaps to some degree."

A chief executive who gives a damn? Fuck. Where did they find him? I don't know which planet this bloke is from but it certainly isn't Earth. This statement makes it sounds like he gives a shit. Can't be. Either he is lying or he's not of this world. ....Anne

"What we want to pay special attention to is working to keep enough nurses on the front lines delivering direct care," says Darrell G. Kirch, president and chief executive of Hershey Medical Center.

You have got to be shitting me.....Anne

Julie Miksit, administrative director of nursing at Good Samaritan Hospital, says creative solutions have allowed the hospital to retain nurses and keep patient safety at a proper level. The hospital has not resorted to mandatory overtime and patient care is not being compromised, she says.

Still, nurses agree that, whether patient safety is affected or not, the shortage robs them of time to give hands-on, bedside assistance, or consoling, friendly conversation -- some of the things that drew them to nursing in the first place.

"My sister was diagnosed with breast cancer and died a year later. That strengthened my need to nurture. Sometimes I say, 'I'm going to leave nursing,' but then something happens to make me see the rewards," says Ivy Matthews, who works in the hospice unit of the VA Medical Center in Lebanon. ***

"I wanted to be a nurse since I was little. My brother was asthmatic since he was a baby. One day I stood on the porch while he turned blue, and I didn't know what to do. I wanted to be able to do something," says Lebanon VA nurse Penny Riehl. ***

Lawmakers have heard the hue and cry of nurses.

Still waiting for this to happen in the UK. I have watched what has happened in the USA over the last 10 years with nurses getting politically active. It hasn't been pretty. The health care lobby is pretty powerful. I have higher hopes for the UK really......Anne

A bill introduced in the state Legislature would limit services that may be performed by unlicensed hospital personnel. Another would protect whistleblowers who report problems at hospitals. A third would mandate the Pennsylvania Health Care Cost Containment Council to collect information on the quality of hospital care.

As far as I know this bill failed in Pennsylvania. The health care lobby is too powerful.......Anne

Rep. Pat Vance, R-Silver Spring Twp., a former nurse, said remedies for the shortage might include establishing a "career ladder" to give nurse's aides more opportunities to become nurses.

Is she on crack? Nurses aides and HCA's don't want to become nurses. They know the score. The fucking nurses want to be HCA's.......Anne

Meanwhile, hospitals are going to great lengths to recruit nurses.

Total fucking lie. I know this region and lived near there around the time this article was written. They made it appear that they were trying to recruit and retain. Kind of like what the NHS is doing now........Anne

Holy Spirit and other hospitals offer "signing bonuses." Lancashire Hall nursing and rehabilitation center in Manheim Twp. has recruited 18 nurses from the Philippines, and 155 other Filipino nurses could be working in area facilities within the next few months.

What about all of the experienced home grown nurses? Don't want to bring them back because they'll blow the whistle on your dangerous practices right fucko?want more pay for having more experience and responsibility. We can't have that now can we?....Anne

The real key, many agree, is to think ahead.

"Trying to market nursing as a good career is where we need to go to attract people to the field," says Good Samaritan's Miksit.

Yeah, Market it all you want. The job sucks. You are just training more nurses to burn them all out and turn them into ex-nurses after 2 years in the field......Anne

"You need to look at recruitment in high school and in junior high and have people with a positive attitude talking about it," agrees Lebanon nurse Marie Garman.

Guess that's me out then...as well as any other frontline nurse........Anne.

The health care system may first have to heal the day-to-day experience of those who should be their strongest recruiters: the men and women on nursing's front lines.

Care diminished:

"The treatments may be given. The bandages may be changed," says Colleen Swisher, who works in an intensive care unit at Holy Spirit. "But, when they are in pain, or they are anxious, or they are emotionally distraught ... if somebody can't be there, they aren't getting the care they deserve. And that happens all the time." ***

One 19-year veteran says she quit her full-time job at Harrisburg Hospital because, as a nurse, "What they are expecting of you is physically impossible to do safely."

There was once said that the UK follows America and sadly this would appear to be a case of us taking a leaf out of "Dubya's" book.

I am sure you can remember when Patsy fuckwith (Sorry, "the Rt Honourable Patricia Hewitt MP") was health secretary and was challenged on the research on Nurse:Patient ratios, she simply state that she "Had not read the reasearch".

Indeed, but you can bet your bottom dollar that if the research called for less nurses she would damn well have read it. Don't you find it odd that just before the nursing cull started we were being told that we were short of nurses? As I said when the cull began, you can imagine the hospitals releasing a statement: "We have sacked all the nurses due to financial shortages, but we have employed 3 risk managers at £65000 per year each so everything is ok, out paperwork says so".

P.S. Either you or A&E charge nurses know of any band D grade 5 jobs comming up near January?

A certain hospital in Yorkshire did just that. They already have the worst nurse/patient ratios in the country and they announced that over 500 jobs are going and that are also advertising for 2 £70,000.00 a year managers to sort out the "mess".

Their stupidity is unbelievable. No money will be saved and patients will get shit services as long as there are poor ratios.

Many hospital Trusts operate a 'protected application' system, i.e. first bite of the cherry to displaced nurses [following ward closures, service reconfiguration, etc].

I have also heard [anecdotally] that there is fierce competition at our Trust [London teaching hospital] for band 5 posts, especially in some of the sexier specialties - I'm sorry I don't know the actual ratios between candidates/jobs.

As you know band 5s in A&E are generally expected to have 6months post-reg experience before being able to apply [unless dual qualified, RMN/RGN, etc].

I really enjoy reading your observations and I'm sure that these qualities will have been noticed in the clinical areas, even if they have not always been fed back to you directly.

Speaking from personal experience I know that many of the Gs make a mental note of the more able students which gives them a slight edge when it comes down to interview.

I have always found clinical performance on the shop floor more reliable that canditates with slicker interview techniques [although I would strongly recommend that you research current issues about the clinical area for any job you apply for].

Re: The post reg expriance. I have wondered about putting down that I have 7 months post registration experiance and then when I get challenged on it reply "Well you said you wanted someone with imagination to apply".

Inspiring blog, everyone can get plenty of information for any topic. Pretty good post, this is one of the most excellent article that I’ve ever read! This is an enormous site and I have to pass on good wishes to you on the content.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.